Tier 1 — must know Canine Endocrine High yield

Cushing's disease

Hyperadrenocorticism · classic PU/PD + panting outpatient · endocrine workup trap-heavy

⏱ 2–3 min read · Topic 3 of 6

Practice Qs

Traps

High

Exam freq.

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Your status

Study mode

Quick anchor

Trigger

Older dog + PU/PD + panting + pot belly

First step

Test the right dog, not just ALP

Confirm

LDDST commonly used

Trap

Steroids can create iatrogenic Cushing's

Exam core — read this first

Classic pattern → PU/PD, polyphagia, panting, pendulous abdomen

Do not diagnose from ALP alone → laboratory support is not definitive by itself

Common endocrine test → LDDST for many stable suspects

Most common treatment → trilostane for pituitary-dependent disease

Clinical mechanism — only what matters

Excess cortisol → insulin resistance + protein catabolism → muscle wasting, hepatomegaly, hyperglycemia risk

Skin thinning → alopecia, poor hair regrowth, calcinosis cutis in severe cases

ADH antagonism → PU/PD and dilute urine

The NAVLE emphasis is not the pathway. It is recognizing the chronic pattern and not overcalling the diagnosis from screening abnormalities.

Pattern recognition

Core pattern

PU/PD Panting Pot-bellied older dog

Supporting clues

Polyphagia Thin skin / poor hair regrowth Bilateral alopecia Recurrent UTI Marked ALP elevation

NAVLE trigger: The chronic “PU/PD + panting + pot belly” cluster is the signal. High ALP helps, but it is never the diagnosis by itself.

Decision core — what NAVLE actually asks

Classic stable suspect

→ Choose endocrine testing rather than diagnosing from routine chemistry alone

Dog receiving chronic exogenous steroids

→ Think iatrogenic hyperadrenocorticism before spontaneous disease

Confirmed pituitary-dependent disease

→ Trilostane is the board-style long-term answer with monitoring

Key interpretation

ALP

↑ Often marked

Common clue, not proof

Urine SG

Often low

Dilute urine with PU/PD

LDDST

Screen / diagnose

Frequently tested choice

CBC

Stress leukogram

Supportive, not diagnostic

Glucose

May be high

Cortisol drives insulin resistance

Iatrogenic clue

Steroid history

History can answer the question

⚠ Marked ALP elevation supports the pattern, but boards often punish diagnosing Cushing's from chemistry alone.

Treatment

PDH

Trilostane

Most common board answer for pituitary-dependent hyperadrenocorticism.

Monitor

Clinical signs + scheduled endocrine monitoring

Over-suppression can create an Addisonian picture, so monitoring matters.

Alt.

Mitotane or surgery for selected cases

The exam usually wants trilostane first unless it is clearly an adrenal tumor question.

NAVLE traps — where students lose marks

High ALP does not equal Cushing's

It is common support, not confirmation. Test the patient with the right clinical pattern.

Ask about steroid exposure

Iatrogenic Cushing's is a classic history-based board trap.

Do not confuse with hypothyroidism

Both can have alopecia, but Cushing's gives PU/PD, panting, polyphagia, and thin skin.

Treatment can overshoot

If therapy suppresses cortisol too far, the dog can look weak or Addisonian.

Differentials — how to separate these on NAVLE

Fast separator: Cushing's is the chronic PU/PD + panting + pot-belly dog. The board often contrasts it with hypothyroidism, diabetes mellitus, and steroid administration.

Disease	PU/PD	Skin pattern	Key separator
Cushing's disease	Yes	Thin skin / poor regrowth	Panting + pot belly + ALP up
Hypothyroidism	No / mild	Symmetric alopecia	Weight gain + lethargy, not classic PU/PD
Diabetes mellitus	Yes	Variable	Persistent hyperglycemia / glycosuria
Iatrogenic Cushing's	Yes	Thin skin	History of chronic glucocorticoids
Chronic liver disease	Variable	Variable	No classic endocrine testing pattern

Mini cases — apply the decision framework

Pattern recognition

11yr Poodle with PU/PD, panting, thin skin, and a pot-bellied appearance has markedly increased ALP. What disease should move up your list first?

History trap

A dog with chronic pruritus on long-term prednisone now has polyuria, panting, and thin skin. What is the most likely explanation?

Therapy

A dog has confirmed pituitary-dependent hyperadrenocorticism. What long-term treatment is most commonly expected on NAVLE?

Clinical application tools

Use these to sanity-check concurrent problems and medication planning. They do not replace endocrine case selection.

Normal values Dose calculator Unit converter

30-second revision

Classic patternPU/PD + panting + pot belly

Supportive labALP often marked ↑

Common testLDDST

Big history questionAsk about steroids

Common treatmentTrilostane

Look-alikeHypothyroidism can mimic the coat

Critical trapALP alone ≠ diagnosis

Practice questions

Pre-built NAVLE-style · Cushing's disease

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Q1Pattern recognition

An older small-breed dog presents with polyuria, polydipsia, panting, polyphagia, and a pendulous abdomen. Which diagnosis best fits this overall pattern?

AHypothyroidism

BHyperadrenocorticism

CAddison's disease

DAcute pancreatitis

EProtein-losing enteropathy

Q2History trap

A dog has been receiving prednisone for months for allergic skin disease and now shows thin skin, panting, and PU/PD. What is the most likely explanation?

APituitary-dependent hyperadrenocorticism

BAdrenal tumor

CIatrogenic hyperadrenocorticism

DHypothyroidism

EDiabetes insipidus

Q3Next best step

A stable dog strongly fits the Cushing's pattern and has a markedly increased ALP. Which next step is most appropriate?

AProceed with endocrine testing rather than diagnosing from chemistry alone

BStart trilostane immediately without confirmation

CDiagnose hypothyroidism because both can cause alopecia

DRule out Cushing's because ALP is nonspecific

EPerform ACTH stimulation only after starting therapy

Q4Treatment

A dog has confirmed pituitary-dependent hyperadrenocorticism. Which long-term treatment is most commonly expected on NAVLE?

APrednisone

BFludrocortisone

CDOCP

DTrilostane

EDesmopressin

Q5Trap question

Which statement about routine laboratory abnormalities in canine Cushing's disease is most accurate?

AA high ALP confirms the diagnosis

BUrine specific gravity is usually high

CRoutine lab changes support the pattern but do not confirm the disease

DA normal CBC rules out Cushing's

EHyperkalemia is expected in most dogs